Early endometrial metastasis from triple-positive breast cancer is a rare phenomenon in young patients, especially when anti-human epidermal growth factor receptor 2 (HER2) target therapy is used as the primary treatment. We present a case of a 24-year-old patient with advanced triple positive breast cancer. The patient developed abnormal uterine bleeding during chemotherapy combined with anti-HER2 therapy (trastuzumab plus pyrotinib). Due to the transvaginal sonography are not characteristic and the low incidence rate of endometrial metastasis from breast cancer, this potential diagnosis was overlooked. The disease progressed rapidly thereafter, and the overall survival was only 13 months. The swift and devastating progression highlight the immense challenges in managing such complex cases. It remains a current challenge to identify such cases at an early stage and explore more effective therapeutic regimens. Based on this case review and previous studies, we speculate that disease progression might be attributed to the absence of endocrine therapy, chemotherapy resistance, or insufficient anti-HER2 therapeutic intensity. This case provides new insights into the metastatic pattern of HER2-positive breast cancer under targeted drug resistance. Clinicians should be alert to the possibility of reproductive system metastasis during anti-tumor treatment. Timely diagnosis and appropriate treatment are expected to improve patient prognosis.

Adolescents and young adults (AYAs; 15-39 years) with cancer face unique ethical challenges. Variations in ethics consultations (ECs) among different AYA age groups remain understudied, despite evolving developmental and psychosocial milestones. A 10-year retrospective review at an academic medical center examined EC cases in AYA oncology patients. Ethicists categorized ethical issues using an institutional 5 domains, 23-category classification schema Decisional Processes, Medical/Surgical Treatments, Patient/Family Behavior, Professional Issues, and Information/Communication. Categories included surrogate decision-making, informed consent, pain management, and resuscitation status/do-not-resuscitate (DNR) order. Multiple categories could be documented per EC. Primary outcomes were (1) the distribution of categories across domains and (2) the prevalence of specific categories among patients, compared across age groups (15-21, 22-29, and 30-39 years) using χ2 or Fisher's exact tests (α = 0.05). Among 59 ECs (mean patient age 26.4 ± 7.1 years; 52.5% female), Decisional Processes accounted for 41% of category applications, followed by Medical/Surgical Treatments (25%), Patient/Family Behavior (12%), Professional Issues (12%), and Information/Communication (9%). A total of 153 categories were recorded. The most common were surrogate decision-making (45%), quality-of-life (QoL) considerations (37%, including QoL deliberations [20%] and treatment-related QoL concerns [17%]), informed consent (20%), and DNR (18%). The distribution was consistent across age groups, except for pain control, observed only in 22-29-year-olds (3/16; p = 0.014). Decision-making primarily drove EC with consistent patterns across the AYA spectrum, except for pain control in 22-29-year-olds. Findings emphasize the need for structured decision-making approaches and age-specific pain management in AYA oncology.

Adolescents and young adults (AYAs) diagnosed with cancer represent a particularly vulnerable group with unique developmental, psychosocial, and functional challenges. Beyond survival, improving health-related quality of life (HRQoL) has become a major priority in cancer survivorship and public health. This umbrella review aimed to critically synthesize evidence from existing systematic reviews and meta-analyses evaluating the effectiveness of physical, psychosocial, and mixed interventions for improving HRQoL and related health outcomes in AYA (e.g., cancer-related fatigue, anxiety, and physical functioning) cancer patients and survivors. A comprehensive search of PubMed/MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and ScienceDirect identified eligible systematic reviews and meta-analyses published between 2015 and 2025. Fifteen reviews were included. Physical activity interventions showed the most consistent moderate benefits, particularly in reducing fatigue and improving physical functioning and domain-specific HRQoL. Psychosocial interventions demonstrated small-to-moderate improvements in anxiety, depression, and emotional well-being. Mixed interventions showed promising but less robust evidence, particularly due to limited long-term follow-up. Overall evidence certainty ranged from low to moderate. Primary study redundancy was minimal (the corrected covered area = 1.7%). Psychosocial interventions, especially exercise-based and psychosocial programs, can improve key HRQoL domains in AYAs with cancer. However, more rigorous long-term studies are required, particularly for combined and digital approaches.

Adolescents and young adults (AYAs) with cancer have unique physical, emotional, and social challenges. We aimed to identify key concerns among AYAs with cancer, evaluate pathways for connecting patients with resources, and inform the development of an AYA oncology program. This study was conducted at Mayo Clinic in Arizona and included English-speaking patients aged 18-39 years with recently diagnosed cancer. Participants completed a modified Needs Assessment Service Bridge questionnaire, which assessed patient-perceived needs with 39 items spanning 7 domains. An AYA nurse navigator discussed each participant's results with them and connected them to the desired resources. Of 52 eligible patients, 32 (62%) completed the questionnaire. Among them, 30 (94%) reported unmet needs in at least 1 domain and 19 (59%) reported unmet needs in 5 or more domains. The domains with the most frequently reported needs were health behaviors and wellness (81%), emotional health (72%), finances and everyday needs (59%), and work- and education-related assistance (56%). Younger participants reported more needs related to school life and scholarships/loans than did older participants. No significant differences were observed between the responses of men and women. Of 133 total needs identified by all participants, 93 (70%) were addressed by connecting patients to relevant resources. Systematic assessment of AYA needs and targeted connection to resources are essential for individualized and developmentally appropriate care. The current study identified key service gaps at our institution and will guide the continued evolution of our comprehensive AYA oncology program.

Non-Hodgkin lymphoma (NHL) is a heterogeneous group of cancers. Published recommendations and guidelines for fertility preservation are very general and heterogeneous. Therefore, a very first meta-analysis analyzing the worldwide-published data on the risk of infertility after treatment of NHL is required to better counsel patients regarding fertility issues and to develop further strategies to evaluate the gonadotoxicity of treatments in NHL. A systematic literature search was conducted using Medline, Embase, and Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (CENTRAL), including articles published since 2000. Exclusion criteria were cases with disease relapse, follow-up of <1 year, testicular NHL, studies with <40% reproductive markers, and case reports. A total of 4602 records were identified. For the systematic review, 58 studies met the inclusion criteria. In this meta-analysis, 51 studies were included. The prevalence of expected infertility is 27% (95% confidence interval [CI] 0.20-0.37) overall, 23% (95% CI: 0.14-0.35) in females, and 35% (95% CI: 0.27-0.44) in males. It is highest after chemotherapy and radiotherapy to the pelvis and testis ± bone marrow transplantation, 43% (95% CI: 0.20-0.69) in females and 57% (95% CI: 0.21-0.86) in males. After alkylating agents in females, it is 24% (95% CI: 0.17-0.34). The results of this review and meta-analysis indicate a broad heterogeneity of data regarding the risk of infertility. Therefore, fertility counseling and, if necessary, fertility preservation measures are mandatory before oncologic treatment for NHL. Prospective studies stratified by chemotherapy regimen and including new treatment regimens are urgently needed.

There is increasing recognition of the critical need to support informal caregivers of young adults with cancer, including parents. Given the unique developmental needs of young adults, cancer diagnosis and treatment have a profound impact on their parents. However, there is limited psychosocial support provided to parents of young adults with cancer to date. Following a program improvement framework, a virtual six-session parent support group curriculum was developed and adapted to provide specialized psychosocial care to parents of young adults receiving cancer care in 2025. The participants provided feedback and completed an evaluation. Thirty-four parents (85% female) of young adults participated, with 19 (55%) completing the evaluation. The majority of participants evaluated the program as accessible (95%) and relevant (84%) to the parent's shared concerns and experiences. The program was highly rated as supportive (95%) engaging (100%) and was unanimously recommended to other parents (100%). Additionally, parents reported feeling more connected to others (79%), empowered with knowledge (90%), and an improved perceived capacity (79%) to navigate the unique concerns related to their young adult's cancer. This novel parent program has the potential to address the distinct psychosocial needs among parents, which are currently overlooked in existing models of young adult cancer care.

Adolescents and young adults (AYAs) with brain tumors are at an increased risk of developing psychiatric disorders. We aimed to investigate the incidence and characteristics of psychiatric disorders in AYA patients with brain tumors. Using the Korean Classification of Diseases, we identified a cohort of AYA patients (aged 15-34 years) diagnosed with malignant brain neoplasms (C71) between 2003 and 2016 from the Korean National Health Insurance Claims Database. The analysis included 7052 patients. The 10-year cumulative incidence rate of psychiatric disorders was 21.5%. The most common psychiatric disorders were neurotic, stress-related, and somatoform disorders (11.4%), followed by mood (affective) disorders (9.4%). Factors associated with a higher incidence of psychiatric disorders included female sex (hazard ratio [HR] 1.16, 95% confidence interval [CI]: 1.05-1.28, p = 0.005), history of seizures (HR: 1.47, 95% CI: 1.31-1.66, p < 0.001), and brain tumor diagnosis during the latter part of the study period (HR: 1.14, 95% CI: 1.03-1.27, p = 0.010). Psychiatric hospital admissions were most frequent among patients with schizophrenia, schizotypal disorders, and delusional disorders (n = 5). The most common psychiatric disorders requiring psychotherapy were neurotic, stress-related, and somatoform (n = 580) and mood (n = 526) disorders. A significant number of AYA patients with brain tumors develop psychiatric disorders after diagnosis, and most require treatment. Early detection through screening programs and personalized psychological support during and after cancer treatment may improve the mental health and quality of life of AYA patients with brain tumors.

We analyzed the predictors of marriage and parenthood in our cohort of adult survivors of childhood cancer. We conducted a retrospective cohort analysis of adult survivors of childhood cancer aged > 25 years at a tertiary cancer center in India, evaluating marital status, parenthood, and associated predictors using multivariable logistic regression. Among 844 survivors, 36.4% of males and 37.6% of females were ever married. On multivariable analysis, male sex (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.41-0.83, p = 0.003) and diagnosis of central nervous system (CNS) tumor/retinoblastoma (OR 0.42, 95% CI 0.22-0.81, p = 0.009) were associated with lower likelihood of marriage, while employment was strongly associated with higher likelihood (OR 3.75, 95% CI 2.62-5.37, p < 0.001).Among married survivors, treatment before 2000 was associated with a higher likelihood of parenthood (OR 3.94, 95% CI 2.20-7.06, p < 0.001), while other treatment-related factors were not significantly associated. Highly gonadotoxic treatment (OR 2.19, 95% CI 1.22-3.93, p = 0.01) was associated with use of assisted reproductive technology. Sociodemographic and temporal factors, particularly employment and treatment era, were the primary determinants of marriage and parenthood in this cohort.

Young adults (YAs) with advanced cancer face distinct medical and psychosocial challenges, making high-quality tailored communication essential. Yet the optimal timing and facilitation of serious illness conversations (SIC) remain variable. This study explores YA and multidisciplinary clinician perspectives on experiences with SIC. Using a prospective, cross-sectional mixed methods design, we surveyed 98 participants 39 YAs aged 18-39 years with advanced disease across cancer types and 59 clinicians across disciplines and cancer specialties. Qualitative data, using basic qualitative description, were integrated to triangulate quantitative findings related to advance care planning (ACP) and palliative care (PC) understanding and to identify SIC barriers, facilitators, and readiness. YAs reported substantial emotional and career/education disruption from cancer. Nearly half (49%) were unsure about ACP, while others linked it with proxy decisions or end-of-life (EOL) planning. Clinicians broadly endorsed similar ACP topics, emphasizing care preferences, code status, and surrogate decision-making. Most YAs (59%) had limited PC knowledge and often equated it with EOL care. Shared SIC barriers included emotional toll and time limits, while a key facilitator was conversation initiation by the other party. Readiness for SIC was tied to emotional acceptance and clinical turning points. YAs with advanced cancer demonstrate varied awareness of ACP, PC, and experiences with SIC. Conversations typically arise at pivotal disease moments, a tipping point, requiring mutual readiness and recognition of changing realities by both patients and clinicians. Earlier and tailored communication may improve concordance of care delivered with YA values and preferences.